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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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OFFICIAL USE ONLY
FILE NUMBER
COUNTY COOE
YEAR
NUMBER
DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S AME (LAST, FIRST, AND MIDDLE INITIAL)
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l&. 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
02. Supplemental Ret
o 4a. Future Interest Compromise (date of dealh after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTNSI)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
SOCIAL SECURITY NUMBER ._
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dale of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A} (Attach Sch 0)
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NAME t
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FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
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1, Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(1)
(2)
(3)
(4)
(5)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
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14. Net Value Subject to Tax (Line 12 minus line 13)
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FFICIAt~SE O~l('(<\
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(9)
(10)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
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x .0_ (15)
x .0 Its (16)
x .12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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(8)
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20.0
(11)
(12)
(13)
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(14)
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(19)
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FlEV-1513 EX+ (9-00)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
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FILE NUMBER
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RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not UstTrustee(s) OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. J f1 J...I E ~.'~..t::;.f\f I-IOUR.
J.fO 9 '?:.ION Ro
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
REV-15Cllb> 11-97)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
1- f-/-E ~ e..
FILE NUMBER
2005 -CJ /CJ7 ~-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
J( It- TlfR. Y AJ
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntJy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. H<r
C3 ftJ./ ~____ _'H_e~~LN~. _ _ ---~.~---- -- 3 ~,S61,.,.. 79
2- r R e- .Efr"lJ2____&_IY.~ ~____~t5:l!.__ ____________________________ lo,32tJ.. 80
--- -~-._-~_...._-- .
TOTAL (Also enter on line 5, Recapitulation) $ L.( J.. I g-,7,5
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(If more space is needed, insert additional sheets of the same size)
REV.1511 EX+ (12-99) .
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
~/+!R-YN
FILE NUMBER
L H-EgR-- Z-CJCJ5--LJi07S-
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
AMOUNT
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....~o~S,oo
________190 , (;> 0
... __._._____.._________.__.__._.. .._ ...__Ii 7:.?_~_?J.~
__"'_ ._________.______._...__.._._. ...... ..._.m.._LJ.JJ.~_2., 0
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DESCRIPTION
FUNERAL EXPENSES: FCfl.EJ.SltlVts::C1/L ~ 8n.l~1l- FuiUint-;k- Hone-,
1-
Pew.~-.SrI1-FF/~/?1iLf.;/~l Fc;N€7<-ifC..~I'fe':.~/t.. t! /:-tteJ..:J,P, A-vro. .
LIt-)~E-r 'f I~T' 12~'f, -- _ .. ......-.. ." -.--..,---- --.--- .'-
.11P..f<lidt!ffa!_C_EIY. ~ Jf-It}./, ~-- -. - ...... ..- -----------.-- -.---------..-.----..--...
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J:.EC1<, nl':lE:p_C(;>tl;g_~____~____ ___ - . m_ - .....
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ADMINISTRATIVE COSTS: --------------..----.---------- -----------dn~/oi-3r"-
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State ~Zip .
Relationship 01 Claimant to Decedent
4.
Probate Fees
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Accountant's Fees
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.00
5.
6.
Tax Return Preparer's Fees
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5',00
7.
TOTAL (Also enter on line 9, Recapitulation) $ I 0 If ~ e c 80
(If more space is needed. insert additional sheets of the same size)
REV-'5'2 EX. (1-971
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
/L tA- JI-I- I?- Y N L
1-1- E g ~
FILE NUMBER
ZOCJS-{;) 10 "7S
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
TOTAL (Also enter on line 10, Recapitulation) $ 7ft:, Z i J.. 9
(If more space IS needed, Insert additional sheets of the same size)
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LAST WILL AND TESTAMENT
I, KATHRYN L. HERR, of the Borough of Shippensburg, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and revoke any
will or codicil previously made by me.
ITEM I: I direct that all my just debts and funeral expenses, including
my gravemarker and all expenses of my last illness, shall be paid from my
residuary estate as soon as practicable after my decease as a part of the
administration of my estate.
ITEM II: I bequeath those articles of my household furniture and
furnishings and those articles of my personal effects and personal property
~ as set fotth in a sepatate memorandum. which I shall place with my will ot
~ deposit with my attorney, to the persons therein designated.
ITEM'III: I give and bequeath all of my tangible personal property (not
~
including cash or securities and not including any tangible personal property
utilized by me in any business, including farming, and not including any
items bequeathed above) including, without limitation, personal effects,
household furniture and furnishings, automobi~s, and' the like, together with
any policies of insurance in effect at the time of my death applicable
thereto, including any prepaid premiums thereon, to such of my children as
survive me to be divided among them as nearly as possible in equal shares in
such manner as they may agree upon or, failing agreement for any reason
whatsoever, then in such manner as my executor shall determine, giving due
regard for their personal preferences.
ITEM IV: I devise and bequeath the residue of my estate of every nature
and wherever situate in equal shares to such of my children, JOHN C. HERR and
II
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JANE L. EISENHOUR, as shall survive me by thirty (30) days.
ITEM V: Should any of my children, JOHN C. HERR or JANE L. EISENHOUR,
predecease me or die on or before the thirtieth day following my death but
leaving issue who so survive me, such issue shall receive, per stirpes, the
share that such predeceased child would have received had he or she so
survived me.
ITEM VI: I appoint his or her respective parent or guardian, guardian
of any property which passes outright either under this will or otherwise to
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a min9r and with respect to which I am authorized to appoint a guardian and
have not otherwise specifically done so, provided that this appointment of a
guardian shall not supersede the right of any fiduciary in its discretion to
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distribute a share where possible to the minor or to another for the minor's
benefit. Such guardian shall have the power to use principal as well as
income from time to time for the minor's support and education (including
secondary, college education, both graduate and undergraduate, professional
arid other education) without regard to his or her parent's ability to provide
for such support and education, or to make payment for these purposes,
without further responsibility to the minor or to the minor's parent or to
any person taking care of the minor.
ITEM VII: I direct that all taxes that may be assessed in consequence
of my death, of whatever nature and by whatever jurisdiction imposed, shall
be paid from my residuary estate as part of the expenses of the
administration of my estate.
ITEM VIII: I appoint my son, JOHN C. HERR, and my daughter, JANE L.
EISENHOUR, executors of this my last will. Should both of my said executors
fail to qualify or cease to act as executors, I appoint my brother-in-law,
2
LLOYD B. HERR, executor of this my last will.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
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and Testament, written on four (4) sheets of paper, dated this ~ day of
Oa1o~
, 1989.
sf ,< O,'T"l.~ 4f0 L ~ 4J~ ~
{ Kathryn L. Herr
(SEAL)
The preceding instrument, consisting of this and three (3) other
typewritten pages, each identified by the signature of the testatrix, was on
the day and date thereof signed, published and declared by the testatrix
therein named, as and for her Last Will~ in the presence of us, who at her
request, in her presence, and in the presence of each other have subscribed
our names as witnesses hereto.
J gAM{L,(j~
C-- ~t'\-U l s.
residing at
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PA
05/ Y E L1>A (Y) - SEASf"
residing at ~h; ~~bu.(~ ) fA
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COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
I, KATHRYN L. HERR, the testatrix whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do
hereby acknowledge that 1 signed and executed the instrument as my Last Will;
and that I signed it willingly and as my free and voluntary act for the
purposes therein expressed.
-I K fl. 71fR. 'IN L. t4 c'""t R-
Kathryn L. Herr
(SEAL)
Sworn to or affirmed and acknowledged
before me by KATHRYN L. HERR,
the testatrix, this 3cs! day of
()(\~\u../ , 1989.
i-~~A ...J:-isue~f-b~t.1t
Notary Public
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
We, ~~lll7I~ C!. ).~lIIS and ~U.l:>A 1)'\. .seAS~ , the
witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present
and saw the testatrix sign and execute the instrument as her Last Will; that
the testatrix signed willingly and executed i~ as her' free and voluntary act
for the purposes therein expressed; that each subscribing witness in the
hearing and sight of the testatrix signed the Will as a witness; and that to
the best of our knowledge' the testatrix was at that time eighteen (18) or
more years of age and of sound mind and under no constraint or undue
influence.
0/ +JAm/<.."''' C.'~~IS
~ VcS,LbA ('n - SE.A-SE
Sworn to or affirmed and subscribed to
before me by +l1J.nltt. 'f## e. ~U15 and
ou~~ nJ. ...s;~74.sr-' , witnesses,
this t3 day of Oclol..J..v- , 1989.
~~rS-/i ..J. ~",,e~J./dl.J~
Notary Public
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
HERR JOHN C
736 MOHNS Hill RD
SINKING SPRING, PA 19608
_~____h fold
ESTATE INFORMATION: SSN: 165-26-5945
FILE NUMBER: 2105-1075
DECEDENT NAME: HERR KATHRYN l
DATE OF PAYMENT: 06/08/2006
POSTMARK DATE: 06/06/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 11/26/2005
NO. CD 006808
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,423.19
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TOTAL AMOUNT PAID:
REMARKS: JOHN HERR
CHECK# 98
SEAL
INITIALS: WZ
RECEIVED BY:
REGISTER OF WILLS
$1,423.19
GLENDA FARNER STRASBAUGH
REGISTER OF WIllS